title: Off-pump transapical implantation of artificial chordae to correct mitral regurgitation: early results of a single-center experience.
abstract: OBJECTIVE
  This study evaluated the safety and efficiency of the NeoChord DS1000 system (NeoChord, Inc, Minneapolis, Minn), a device designed to deliver artificial chordae tendineae (neochords) in a beating heart with minimally invasive techniques through left anterolateral minithoracotomy.
  
  
  METHODS
  Thirteen patients with severe mitral regurgitation and isolated posterior mitral valve leaflet prolapsed underwent operation with the NeoChord DS1000 system. Mitral valve dimensions were anteroposterior 34 mm (29-45 mm) and mediolateral 40 mm (29-58 mm). All patients had an ejection fraction greater than 55%. With a beating heart, through a left anterolateral thoracotomy, under transesophageal echocardiographic guidance, the NeoChord DS1000 was introduced into the left ventricle 2 to 4 cm posterolateral from the apex. The prolapsed leaflet was grasped with the device, and expanded polytetrafluoroethylene suture deployed and attached to the posterior leaflet. Six patients received 2 sutures, 4 received 3 sutures, and 2 received 4 sutures. All patients reached 6 months' follow-up and underwent transthoracic echocardiography to evaluate mitral regurgitation.
  
  
  RESULTS
  Median operative duration was 113 minutes (80-150 minutes). Less than second-degree mitral regurgitation in 6 months was achieved in 11 patients (85%). One patient (8%) had recurrent mitral regurgitation in 1 month, and another had conversion to conventional mitral valve repair because of leaflet damage with the device. There were no further serious procedure-related complications.
  
  
  CONCLUSIONS
  Beating-heart transapical neochord implantation was feasible, could be performed safely, and resulted in a relatively short procedure time. Larger studies and longer follow-up are needed to validate these promising results.
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Kestutis
authors.initials: K
authors.lastname: Rucinskas
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania. Electronic address: janvilius@yahoo.com.
authors.forename: Vilius
authors.initials: V
authors.lastname: Janusauskas
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Diana
authors.initials: D
authors.lastname: Zakarkaite
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Sigita
authors.initials: S
authors.lastname: Aidietiene
authors.affiliation: Centre of Anaesthesia, Intensive Care, and Pain Management, Department of Intensive Care, Vilnius University, Vilnius, Lithuania.
authors.forename: Robertas
authors.initials: R
authors.lastname: Samalavicius
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Physicians, Pittsburgh, Pa.
authors.forename: Giovani
authors.initials: G
authors.lastname: Speziali
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Audrius
authors.initials: A
authors.lastname: Aidietis
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D002815:Chordae Tendineae / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008097:Lithuania; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D013318:Stroke Volume; D013536:Suture Techniques; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: 28; 35.4.1; LV; MR; TACT; TEE; Transapical Artificial Chordae Tendineae [trial]; left ventricle; mitral regurgitation; transesophageal echocardiography